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Ramasubramani P, Krishnamoorthy Y, Rajaa S. Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother-child pairs in India: Findings from a nationally representative survey (NFHS-5). Heliyon 2024; 10:e37794. [PMID: 39315197 PMCID: PMC11417156 DOI: 10.1016/j.heliyon.2024.e37794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Improper consumption of food leads to various forms of malnutrition such as undernutrition, overnutrition and micronutrient deficiency. The coexistence of various malnutrition forms in the same household is a public health concern in developing countries. Very little research has been done on exploring the burden and risk factors associated with double (DBM) and triple burden of malnutrition (TBM). Methods Secondary analysis was done using data from India's National Family Health Survey-5 (NFHS-5), 2019-21. Mothers and under-five children were paired at the household level as a unit of analysis. DBM and TBM were interpreted from children's height-for-age, weight-for-height, weight-for-age and anaemia status and mothers' body-mass-index. Stratification and clustering in the sample design were accounted for during the analysis in STATA v14.2. DBM and TBM were summarized as weighted proportions with 95 % confidence interval (CI) and the risk factors associated were reported as adjusted odds ratio (aOR) with 95%CI using mixed effects logistic regression. Results We included 167,380 mother-child pairs for analysis. In India, the prevalence of DBM was 7.7 % (95 % CI: 7.5-7.9 %) and TBM was 5.1 % (5.0-5.3 %) at the household level among mother-child dyads. Mothers' age, age at first birth, educational levels, current breastfeeding habits, mode of delivery, child's age, gender, twin birth, birth weight, geographical region, residence, caste and religion, and wealth index were associated with both DBM and TBM. Conclusion Both DBM and TBM are public health concerns in India. Thus, scaling-up of health intervention, effective implementation of nutritional programmes and life-course approach are needed to control malnutrition.
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Affiliation(s)
- Premkumar Ramasubramani
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Yuvaraj Krishnamoorthy
- Evidence Synthesis Unit, Partnerships for Research, Opportunities, Planning, Upskilling, Leadership (PROPUL) Evidence, Chennai, India
| | - Sathish Rajaa
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
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Singh S, Shri N, Singh A. Inequalities in the prevalence of double burden of malnutrition among mother-child dyads in India. Sci Rep 2023; 13:16923. [PMID: 37805548 PMCID: PMC10560231 DOI: 10.1038/s41598-023-43993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/09/2023] Open
Abstract
In the midst of rapid urbanization and economic shifts, the global landscape witnesses a surge in overweight and obese individuals, even as child malnutrition persists as a formidable public health challenge in low- and middle-income countries (LMICs). This study seeks to unravel the prevalence of the double burden of malnutrition (DBM) within the context of India and delve into the associated disparities rooted in wealth. This study leverages data from the fifth wave of the National Family and Health Survey (NFHS-5), a nationally representative survey conducted in the year 2019-21 in India. This study focuses on mother-child dyads with children under the age of 3 years. Descriptive, bivariate and logistic regression analysis is used to decipher the intricate web of DBM's prevalence and risk factors, as underscored by socio-demographic attributes. Wagstaff decomposition analysis is applied to quantify the contribution of each inequality in the social determinants on the observed income-related inequality in the DBM. Result from bivariate and logistic regression indicated a heightened risk of DBM within households marked by C-section births, affluence, ongoing breastfeeding practices, advanced maternal age, and larger household sizes. Additionally, households harbouring women with abdominal obesity emerge as hotspots for elevated DBM risk. Notably, the interplay of abdominal obesity and geographical disparities looms large as drivers of substantial inequality in DBM prevalence, whereas other factors exert a comparably milder influence. As India grapples with the burgeoning burden of DBM, a conspicuous imbalance in its prevalence pervades, albeit inadequately addressed. This juncture warrants the formulation of dual-purpose strategies, and a slew of innovative actions to deftly navigate the complex challenges poised by the dual burden of malnutrition. Amidst these exigencies, the imperative to forge a holistic approach that encompasses both sides of the malnutrition spectrum remains a beacon guiding the quest for equitable health and nutrition outcomes.
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Affiliation(s)
- Saurabh Singh
- International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
| | - Neha Shri
- International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India.
| | - Akancha Singh
- International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
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Andriani H, Friska E, Arsyi M, Sutrisno AE, Waits A, Rahmawati ND. A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys. BMC Public Health 2023; 23:1836. [PMID: 37735644 PMCID: PMC10512541 DOI: 10.1186/s12889-023-16728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia. METHODS We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics. RESULTS Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds. CONCLUSION TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.
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Affiliation(s)
- Helen Andriani
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Erlin Friska
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Miftahul Arsyi
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Alphyyanto Eko Sutrisno
- Master of Public Health Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Alexander Waits
- Institute of Public Health, International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nurul Dina Rahmawati
- Department of Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
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Sahiledengle B, Mwanri L, Agho KE. Association between maternal stature and household-level double burden of malnutrition: findings from a comprehensive analysis of Ethiopian Demographic and Health Survey. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:7. [PMID: 36691083 PMCID: PMC9872360 DOI: 10.1186/s41043-023-00347-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Undernutrition among under-five children is one of the intractable public health problems in Ethiopia. More recently, Ethiopia faced a rising problem of the double burden of malnutrition-where a mother may be overweight/obese, and a child is stated as having undernutrition (i.e., stunting, wasting, or underweight) under the same roof. The burden of double burden of malnutrition (DBM) and its association with maternal height are not yet fully understood in low-income countries including Ethiopia. The current analysis sought: (a) to determine the prevalence of double burden of malnutrition (i.e., overweight/obese mother paired with her child having one form of undernutrition) and (b) to examine the associations between the double burden of malnutrition and maternal height among mother-child pairs in Ethiopia. METHODS We used population-representative cross-sectional pooled data from four rounds of the Ethiopia Demographic and Health Survey (EDHS), conducted between 2000 and 2016. In our analysis, we included children aged 0-59 months born to mothers aged 15-49 years. A total of 33,454 mother-child pairs from four waves of EDHS were included in this study. The burden of DBM was the primary outcome, while the maternal stature was the exposure of interest. Anthropometric data were collected from children and their mothers. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. The association between the double burden of malnutrition and maternal stature was examined using hierarchical multilevel modeling. RESULTS Overall, the prevalence of the double burden of malnutrition was 1.52% (95% CI 1.39-1.65). The prevalence of overweight/obese mothers and stunted children was 1.31% (95% CI 1.19-1.44), for overweight/obese mothers and wasted children, it was 0.23% (95% CI 0.18-0.28), and for overweight/obese mothers and underweight children, it was 0.58% (95% CI 0.51-0.66). Children whose mothers had tall stature (height ≥ 155.0 cm) were more likely to be in the double burden of malnutrition dyads than children whose mothers' height ranged from 145 to 155 cm (AOR: 1.37, 95% CI 1.04-1.80). Similarly, the odds of the double burden of malnutrition was 2.98 times higher for children whose mothers had short stature (height < 145.0 cm) (AOR: 2.98, 95% CI 1.52-5.86) compared to those whose mothers had tall stature. CONCLUSIONS The overall prevalence of double burden of malnutrition among mother-child pairs in Ethiopia was less than 2%. Mothers with short stature were more likely to suffer from the double burden of malnutrition. As a result, nutrition interventions targeting households' level double burden of malnutrition should focus on mothers with short stature to address the nutritional problem of mother and their children, which also has long-term and intergenerational benefits.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Lillian Mwanri
- grid.449625.80000 0004 4654 2104Centre for Public Health Research, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, SA 5000 Australia
| | - Kingsley Emwinyore Agho
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.1029.a0000 0000 9939 5719School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW 2571 Australia ,grid.16463.360000 0001 0723 4123African Vision Research Institute, University of KwaZulu-Natal, Durban, 4041 South Africa
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Poppy GM, Baverstock-Poppy JJ, Baverstock J. Trade and dietary preferences can determine micronutrient security in the United Kingdom. NATURE FOOD 2022; 3:512-522. [PMID: 37117938 DOI: 10.1038/s43016-022-00538-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/19/2022] [Indexed: 04/30/2023]
Abstract
Food production, dietary choices, climate change, trade tariffs and future responses to the SARS-CoV-2 pandemic are some of the factors affecting global food security. Here we examine how micronutrient security has varied in the United Kingdom from 1961 to 2017, before Brexit, taking supply and demand driver changes into account. We also introduce future scenarios to see how a more plant-based diet and/or differing trade arrangement post-European Union exit and COVID-19 pandemic could affect the supply of nutrients. Results show that trading agreements have affected several key micronutrients during the past 60 years and are likely to be influential in a post-Brexit United Kingdom. Changes in dietary patterns, which influence how much animal- and plant-based products are consumed, have also affected micronutrient security and are likely to do so in the future with increased interest in consuming a more plant-based diet.
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Affiliation(s)
- Guy Matthew Poppy
- School of Biological Sciences, University of Southampton, Southampton, UK.
| | | | - Jenny Baverstock
- School of Biological Sciences, University of Southampton, Southampton, UK
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Sutopa TS, Bari W. How does mode of delivery associate with double burden of malnutrition among mother-child dyads?: a trend analysis using Bangladesh demographic health surveys. BMC Public Health 2022; 22:1243. [PMID: 35733171 PMCID: PMC9219174 DOI: 10.1186/s12889-022-13660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The simultaneity of undernourishment among child and overweight/obesity among mothers in lower-and-middle-income-countries (LMICs) introduces a new nutrition dilemma, known as double burden of malnutrition (DBM). Amidst of such paradox, the hike of caesarean section (CS) delivery is also triggering child undernutrition and maternal obesity. A gap of knowledge regarding the effect of mode of delivery on DBM still persists. The study aims to explore the association between DBM at household level and mode of delivery over time in LMICs. METHOD The study used data from recent four consecutive waves of Bangladesh Demographic and Health Survey (BDHS) ranging from BDHS 2007 to BDHS 2017. It considered the mother-child pairs from data where mothers were non-pregnant women aged 15-49 years having children born in last 3 years preceding the survey. Bivariate analysis and Logistic Regression were performed to explore the unadjusted and adjusted effect of covariates on DBM. An interaction term of mode of delivery and survey year was considered in regression model. RESULTS The study evinces a sharp increase of DBM rate in Bangladesh from 2007 to 2017 (2.4% vs. 6.4%). The prevalence of DBM in household level among the children delivered by CS is more than two times of those born by normal delivery (8.2% vs. 3.5%). The multivariate analysis also indicates that the children born by CS delivery are more likely to be affected by DBM at household level significantly than those born by normal delivery in each waves. Moreover, the odds ratio (OR) of DBM at household is increased by 43% for one unit change in time for normal delivery whereas CS delivery births have 12% higher odds of DBM at household level with one unit change in time. CONCLUSION The study discloses a drastic increase of rate of DBM among mother-child pairs over the time. It stipulates inflated risk of DBM at household with time for both mode of delivery but the children with CS delivery are at more risk to the vulnerability of DBM at household level. The study recommends a provision of special care to the mothers with CS delivery to reduce DBM at household.
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Affiliation(s)
| | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Kumar M, Mohanty P. Does maternal overnutrition carry child undernutrition in India? PLoS One 2022; 17:e0265788. [PMID: 35714070 PMCID: PMC9205528 DOI: 10.1371/journal.pone.0265788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Studies in low-and middle-income countries where nutrition transition is underway provides mixed evidence of double burden of maternal overnutrition and child undernutrition among mother-child pairs. Shifting dietary pattern and rapid increase in overweight/obesity among adults with persistent child undernutrition indicate that India is experiencing nutrition transition and double burden of malnutrition. Hence, the study explores the presence of and the factors associated with mother-child dyads of over- and undernutrition in India. Methods and materials The study uses National Family Health Survey 2015–16 data. The analytic sample consists of 28,817 weighted mother-child pairs where an overweight/obese mother is paired with an undernourished child. The nutritional status of children is defined according to WHO 2006 child growth standards as underweight (i.e., low weight-for-age), stunting (i.e., low height-for-age) and wasting (i.e., low weight-for-height). Maternal overweight/obesity (i.e., BMI ≥ 25 kg/m2) is defined using adult BMI criterion. Descriptive, bivariate, and adjusted multivariable logistic regression analysis are conducted. Results Of the overweight/obese mothers, 21.3%, 26.5%, and 14% have underweight, stunted, and wasted children respectively. In adjusted models, maternal short stature (aOR: 2.94, 95% CI: 2.30–3.75), age of child (aOR: 3.29, 95% CI: 2.76–3.92), and poorest wealth status (aOR: 2.01, 95% CI: 1.59–2.54) are significant predictors of overweight/obese mothers and stunted child pairs. Similarly, poor wealth status (aOR: 1.68, 95% CI:1.32–2.14), maternal stature (aOR: 2.70, 95% CI: 2.08–3.52), and child aged 2–5 years (aOR: 1.77, 95% CI:1.51–2.08) are also significantly associated with higher occurrence of overweight/obese mother and-underweight child pairs. Conclusion Findings of the study are consistent with the phase of nutrition transition and double burden of malnutrition. The paper concludes with suggestions to improve the socioeconomic condition, more strategic nutrition specific investments and policy interventions to eliminate all forms of malnutrition for achieving SDGs.
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Affiliation(s)
- Mukesh Kumar
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
| | - Pratap Mohanty
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
- * E-mail:
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Christian AK, Dake FAA. Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors. Public Health Nutr 2022; 25:1563-1576. [PMID: 33896443 PMCID: PMC9991556 DOI: 10.1017/s1368980021001750] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/29/2021] [Accepted: 04/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. SETTING The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. PARTICIPANTS The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years). DESIGN Logistic regression analyses were used to determine household correlates of household burden of malnutrition. RESULTS Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. CONCLUSIONS The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.
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Affiliation(s)
- Aaron K Christian
- Regional Institute for Population Studies, University of Ghana, LG 96 Legon, Accra, Ghana
| | - Fidelia AA Dake
- Regional Institute for Population Studies, University of Ghana, LG 96 Legon, Accra, Ghana
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Guevara-Romero E, Flórez-García V, Egede LE, Yan A. Factors associated with the double burden of malnutrition at the household level: A scoping review. Crit Rev Food Sci Nutr 2021; 62:6961-6972. [PMID: 33840313 DOI: 10.1080/10408398.2021.1908954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The double burden of malnutrition (DBM) at the household level has been defined as the coexistence of underweight children and overweight mothers within the same household. The objective of the scoping review was to identify and understand factors associated with DBM. We conducted the scoping review of published, peer-reviewed journal articles in two major databases used in public health research (PubMed and Web of Science). A total of 70 articles met the eligibility criteria. The following factors were identified: mother's age, height, educational level, occupation, food intake, breastfeeding, family income, family size, and urbanization type. Overall, results were heterogeneous. Two scenarios have been identified. The first scenario is those obese women with a job, having a sufficient income, a high educational level, the ability to purchase food, and live either in rural or urban areas. The second scenario is obese women without a job, having an insufficient income, a low educational level, without the ability to purchase food, and live either in rural or urban areas. The DBM at the household level is a complex public health problem. There is a need for target-specific interventions to address child undernutrition and maternal overweight/obesity simultaneously.
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Affiliation(s)
- Edwin Guevara-Romero
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Víctor Flórez-García
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA.,Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Leonard E Egede
- Center for Advancing Population Science, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alice Yan
- Center for Advancing Population Science, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Socio-economic status and the double burden of malnutrition in Cambodia between 2000 and 2014: overweight mothers and stunted children. Public Health Nutr 2021; 24:1806-1817. [PMID: 33632364 PMCID: PMC8094435 DOI: 10.1017/s1368980021000689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time. DESIGN We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon. PARTICIPANTS We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers. SETTING Nationally representative household survey across all regions. RESULTS SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. CONCLUSIONS Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.
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Prevalence and regional variations of coexistence of child stunting and maternal overweight or obesity in Myanmar. Public Health Nutr 2020; 24:2248-2258. [PMID: 32677600 DOI: 10.1017/s136898002000186x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current study aimed to investigate double burden of malnutrition within households at the national and subnational levels and to identify its association with sociodemographic factors in Myanmar. DESIGN All the variables were extracted from children's file of the Myanmar Demographic and Health Survey 2015-2016. Children under five were identified as stunted based on a height-for-age < -2 sd below the WHO reference median. Maternal overweight/obesity was defined as a BMI ≥ 23 kg/m2. A stunted child with an overweight/obese mother (SCOM) was classified as a double-burden household. SETTING A national household survey in Myanmar. PARTICIPANTS Children under five and their mothers (n 3954 pairs). RESULTS Mean ages of children and mothers were 29 (se 0·14) months and 30·9 (se 0·32) years, respectively. National prevalence of childhood stunting and maternal overweight/obesity was 28·0 % and 39·4 %, respectively, and the prevalence of SCOM was 9·1 %. Significant regional differences were found in SCOM, ranging from 3·6 % in Naypyitaw to 12 % in Kachin and Mon and 14·6 % in Kayah. In the multinomial logistic regression analysis, relative to neither a stunted child nor an overweight/obese mother, child's age, maternal age, maternal experience of a teen birth, short mothers, mothers with primary education and in middle or rich wealth tertiles, and some regions (Kachin, Kayah, Shan, Sagaing, Taninthayi, Ayeyarwaddy, Mon and Yangon) were associated with greater odds of SCOM. CONCLUSIONS The current study showed a relatively high national prevalence of SCOM and significant regional variations. Overarching policies and programmes with culturally sensitive strategies need to be formulated and implemented.
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Sunuwar DR, Singh DR, Pradhan PMS. Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey. BMC Public Health 2020; 20:405. [PMID: 32223749 PMCID: PMC7104542 DOI: 10.1186/s12889-020-8356-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household. METHODS A total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). RESULTS Prevalence of DBM and TBM was 6.60% (95% CI: 5.13-8.84) and 7.00% (95% CI: 5.42-8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04-8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17-5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20-7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45-10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28-5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26-9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. CONCLUSIONS Overall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal APF Hospital, Kathmandu, Nepal.
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
- Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Anik AI, Rahman MM, Rahman MM, Tareque MI, Khan MN, Alam MM. Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar. PLoS One 2019; 14:e0221274. [PMID: 31419251 PMCID: PMC6697370 DOI: 10.1371/journal.pone.0221274] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The coexistence of overweight mother and stunted child at the same household is a type of Double Burden of Malnutrition at Household Level (DBMHL). This particular public health concern is now emerging at an alarming rate among most of the South Asian and its neighboring lower-and-middle income countries which are going through nutritional transition. This study has examined the prevalence rate and the risk factors of DBMHL along with the socio-economic inequality in DBMHL among Bangladesh, Nepal, Pakistan, and Myanmar. METHODS Latest Demographic and Health Survey datasets were used in this study. To identify the significant association of DBMHL with socio-demographic characteristics, a multivariate technique named as logistic regression model, and for measuring socio-economic inequalities in DBMHL prevalence, relative index of inequality (RII) and slope index of inequality (SII) were used. RESULTS The prevalence rates of DBMHL were 4.10% (urban: 5.57%, rural: 3.51%), 1.54% (urban: 1.63%, rural: 1.42%), 3.93% (urban: 5.62%, rural: 3.20%), and 5.54% (urban: 6.16%, rural: 5.33%) respectively in Bangladesh, Nepal, Pakistan, and Myanmar. The risk ratios (RR) obtained from RII for Bangladesh, Nepal, Pakistan and Myanmar were 1.25, 1.25, 1.14, and 1.09, respectively, and β coefficient from SII were 0.01, 0.004, 0.005, and 0.006 unit respectively. In addition to not breastfeeding [Bangladesh (AOR: 1.55; 95% CI: 1.11-2.15), Myanmar (AOR: 1.74; 95% CI: 1.02-2.95)], respondent's older age (in Bangladesh, Nepal, and Myanmar), child's older age (in Pakistan and Myanmar), and middle and rich groups of wealth-index (in Bangladesh and Pakistan) were strong risk factors for DBMHL. On the other hand, female child [Nepal (AOR: 0.50; 95% CI: 0.26-0.95), Pakistan (AOR: 0.58; 95% CI: 0.41-0.84)], higher education [in Pakistan], respondent not participated in decision making [in Bangladesh and Nepal] and media access [Nepal (AOR: 0.44; 95% CI: 0.20-0.98)] had negative association with DBMHL. CONCLUSION The DBMHL persists in all selected countries, with a higher prevalence in urban areas than in rural areas. In order to control the higher prevalence of DBMHL in urban areas, respective countries need urgent implementation of multisectoral actions through effective policies and empowering local communities.
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Affiliation(s)
- Asibul Islam Anik
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Ismail Tareque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - M. Mahmudul Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Uzêda JCO, Ribeiro-Silva RDC, Silva NDJ, Fiaccone RL, Malta DC, Ortelan N, Barrato ML. Factors associated with the double burden of malnutrition among adolescents, National Adolescent School-Based Health Survey (PENSE 2009 and 2015). PLoS One 2019; 14:e0218566. [PMID: 31199844 PMCID: PMC6570028 DOI: 10.1371/journal.pone.0218566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/04/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To assess the sociodemographic factors associated with the double burden of malnutrition (DBM) among Brazilian adolescents. Methods This was a descriptive study based on data from 59,637 and 10,770 students who participated in the National Adolescent School-Based Health Survey (PeNSE), 2009 and 2015 editions, respectively. Weight and height measurements were obtained to evaluate nutritional status. DBM was classified as follows: adolescents with high BMI-for-age and low height-for-age (BMI/A: Z-score > +1 and H/A: Z-score < -2). Sociodemographic data on the participants were also collected. A multinomial logistic regression analysis was used to detect associations of interest. Results The prevalence of DBM in the 2009 and 2015 editions of the PeNSE was 0.4% and 0.3%, respectively. In the 2009 edition, the chance of DBM was lower among boys (OR = 0.60; 95% CI = 0.45–0.81) and higher among those over 14 years old (OR = 2.40; 95% CI = 1.80–3.20), living in the country’s north and northeast regions (OR = 2.01; 95% CI = 1.49–2.84), and from families with a low maternal education level (OR = 1.48; 95% CI = 1.07–2.04). In the 2015 edition, no significant associations were found regarding the DBM outcome. Conclusion The results indicate the presence of socioeconomic inequalities in the occurrence of DBM in the 2009 edition of the PeNSE. Simultaneous interventions in the area of equity are necessary to prevent the advancement of nutrition-related problems.
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Affiliation(s)
- Júlia Caffé Oliveira Uzêda
- Departamento Ciência da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Rita de Cássia Ribeiro-Silva
- Departamento Ciência da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Salvador, Bahia, Brasil
- * E-mail:
| | | | | | - Débora C. Malta
- Universidade Federal de Minas Gerais – Escola de Enfermagem, Belo Horizonte (MG), Brasil
| | - Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Instituto Gonçalo Moniz. Fundação Oswaldo Cruz – FIOCRUZ, Salvador, Bahia, Brasil
| | - Maurício L. Barrato
- Instituto de Saúde Coletiva (ISC), Universidade Federal da Bahia, Salvador, Bahia, Brasil
- Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Instituto Gonçalo Moniz. Fundação Oswaldo Cruz – FIOCRUZ, Salvador, Bahia, Brasil
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Socio-economic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4. Eur J Clin Nutr 2019; 73:1361-1372. [PMID: 30809007 DOI: 10.1038/s41430-019-0406-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Most interventions to foster child growth and development in India focus on improving food quality and quantity. We aimed to assess the pattern in food consumption and dietary diversity by socioeconomic status (SES) among Indian children. SUBJECTS/METHODS The most recent nationally representative, cross-sectional data from the National Family Health Survey (NFHS-4, 2015-16) was used for analysis of 73,852-74,038 children aged 6-23 months. Consumption of 21 food items, seven food groups, and adequately diversified dietary intake (ADDI) was collected through mother's 24-h dietary recall. Logistic regression models were conducted to assess the association between household wealth and maternal education with food consumption and ADDI, after controlling for covariates. RESULTS Overall, the mean dietary diversity score was low (2.26; 95% CI:2.24-2.27) and the prevalence of ADDI was only 23%. Both household wealth and maternal education were significantly associated with ADDI (OR:1.28; 95% CI:1.18-1.38 and OR:1.75; 95% CI:1.63-1.90, respectively), but the SES gradient was not particularly strong. Furthermore, the associations between SES and consumption of individual food items and food groups were not consistent. Maternal education was more strongly associated with consumption of essential food items and all food groups, but household wealth was found to have significant influence on intake of dairy group only. CONCLUSIONS Interventions designed to improve food consumption and diversified dietary intake among Indian children need to be universal in their targeting given the overall high prevalence of inadequate dietary diversity and the relatively small differentials by SES.
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